Quality Practice Performance Manager

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General Information

Job Posting ID 3664271 Creation Date Feb 19, 2019
Employer Posting No --- Closing Date Mar 20, 2019
Job Site Address WACO, Texas 76712 Employer Type Private Sector
Openings 1

Job Description

Primary Responsibilities:
Program implementation and provider performance management which is tracked by designated provider metrics, inclusive minimally of 4 STAR gap closure and coding accuracy
Work directly with care providers to build relationships, ensure effective education and reporting, proactively identify performance improvement opportunities through analysis and discussion with subject matter experts; and influence provider behavior to achieve needed results
Functioning independently, travel across assigned territory to meet with providers to discuss UHG tools and programs focused on improving the quality of care for Medicare Advantage Members
Execute applicable provider incentive programs for health plan
Establish positive, long-term, consultative relationships with physicians, medical groups, IPAs and ACOs
Develop comprehensive, provider-specific plans to increase their HEDIS performance and improve their outcomes
Provide ongoing strategic recommendations, training and coaching to provider groups on program implementation and barrier resolution
Act as lead to pull necessary internal resources together in order to provide appropriate, effective provider education, coaching and consultation. Training will include Stars measures (HEDIS / CAHPS / HOS / med adherence), and Optum program administration, use of plan tools, reports and systems
Coordinate and lead Stars-specific JOC meetings with provider groups with regular frequency to drive continual process improvement and achieve goals
Provide reporting to health plan leadership on progress of overall performance, gap closure, and use of virtual administrative resource
Facilitate / lead monthly or quarterly meetings, as required by plan leader, including report and material preparation
Provide suggestions and feedback to Optum and health plan
Work collaboratively with health plan market leads to make providers aware of Plan-sponsored initiatives designed to assist and empower members in closing gaps
Participate within department campaigns to improve overall quality improvements within measure star ratings or contracts
Work internally with leadership on adhoc projects, initiatives, and sprints to address measure star ratings and increase overall measure performance
Create strategy and action plans for targeted provider groups to increase healthcare delivery, star ratings, and maximize on gap closures
Includes up to 75% local travel
Required Qualifications:
5+ years of healthcare industry experience
3+ years of experience working for a health plan and / or for a provider's office
Microsoft Office specialist with exceptional analytical and data representation expertise; Proficient Excel, Outlook, and PowerPoint skills
Ability to travel locally up to 75% of the time
Strong communication and presentation skills
Strong relationship building skills with clinical and non-clinical personnel

Preferred Qualifications:
Bachelorís degree
1+ year of STARs / HEDIS experience
Strong knowledge of the Medicare market
Active and unrestricted RN license in current state of residence
Medical / clinical background
Strong knowledge of electronic medical record systems
Consulting experience
Knowledge base of clinical standards of care, preventive health, and Stars measures
Experience in managed care working with network and provider relations / contracting
Strong problem-solving skills
Strong financial analytical background within Medicare Advantage plans (Risk Adjustment / STARS Calculation models)
Supervisory Experience Required No
Shift Days (First) Duration Regular
Workweek Full Time
Veterans Only No
Federal Contractor No
Eagle Ford Shale Job No
Is this job related to Hurricane Harvey Clean-up/Restoration? No

Job Requirements

Occupation Medical and Health Services Managers
Minimum Experience and Education  0 yrs   6 mos and High School Diploma/GED
- OR -
 0 yrs   6 mos and Bachelors Degree

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Job Title Quality Practice Performance Manager
The employer did not provide an internal job posting number. Please locate this number on their web site and enter it here: Job Posting Number.
Job Closing Date Mar 20, 2019
Open Until Filled No

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